Provider Demographics
NPI:1144205840
Name:PRIEM, SUSAN MARY (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:PRIEM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 CHOWEN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2121
Mailing Address - Country:US
Mailing Address - Phone:612-805-2741
Mailing Address - Fax:612-922-9177
Practice Address - Street 1:5201 CHOWEN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2121
Practice Address - Country:US
Practice Address - Phone:612-805-2741
Practice Address - Fax:612-922-9177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN348G0PROtherBLUE CROSS/BLUE SHIELD